|
STENT RAINS FRONTAL SINUS LARGE 7089-0931
|
Facility
|
IP
|
$896.00
|
|
| Hospital Charge Code |
3701495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$439.04 |
| Max. Negotiated Rate |
$824.32 |
| Rate for Payer: Aetna Commercial |
$806.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$770.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$474.88
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$824.32
|
| Rate for Payer: Health EOS Commercial |
$797.44
|
| Rate for Payer: HFN Commercial |
$824.32
|
| Rate for Payer: Multiplan Commercial |
$716.80
|
| Rate for Payer: NAPHCARE Commercial |
$537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$824.32
|
| Rate for Payer: Quartz Beloit One Network |
$439.04
|
| Rate for Payer: Quartz Commercial |
$537.60
|
| Rate for Payer: WEA Trust Commercial |
$492.80
|
| Rate for Payer: WPS Commercial |
$663.67
|
|
|
STENT RAINS FRONTAL SINUS STD 7089-0932
|
Facility
|
OP
|
$896.00
|
|
| Hospital Charge Code |
3701496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.88 |
| Max. Negotiated Rate |
$3,584.00 |
| Rate for Payer: Aetna Commercial |
$806.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$770.56
|
| Rate for Payer: Aetna Managed Medicare |
$250.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$582.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$448.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$430.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$474.88
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$824.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$501.40
|
| Rate for Payer: Health EOS Commercial |
$797.44
|
| Rate for Payer: HFN Commercial |
$824.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$672.00
|
| Rate for Payer: Multiplan Commercial |
$716.80
|
| Rate for Payer: NAPHCARE Commercial |
$537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$824.32
|
| Rate for Payer: Quartz Beloit One Network |
$439.04
|
| Rate for Payer: Quartz Commercial |
$582.40
|
| Rate for Payer: Quartz Medicare Advantage |
$537.60
|
| Rate for Payer: The Alliance Commercial |
$3,584.00
|
| Rate for Payer: WEA Trust Commercial |
$492.80
|
| Rate for Payer: WPS Commercial |
$663.67
|
|
|
STENT RAINS FRONTAL SINUS STD 7089-0932
|
Facility
|
IP
|
$896.00
|
|
| Hospital Charge Code |
3701496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$439.04 |
| Max. Negotiated Rate |
$824.32 |
| Rate for Payer: Aetna Commercial |
$806.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$770.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$474.88
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$824.32
|
| Rate for Payer: Health EOS Commercial |
$797.44
|
| Rate for Payer: HFN Commercial |
$824.32
|
| Rate for Payer: Multiplan Commercial |
$716.80
|
| Rate for Payer: NAPHCARE Commercial |
$537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$824.32
|
| Rate for Payer: Quartz Beloit One Network |
$439.04
|
| Rate for Payer: Quartz Commercial |
$537.60
|
| Rate for Payer: WEA Trust Commercial |
$492.80
|
| Rate for Payer: WPS Commercial |
$663.67
|
|
|
STENT RX BILIARY 10FR 10CM
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.70 |
| Max. Negotiated Rate |
$1,499.60 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$978.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RX BILIARY 10FR 10CM
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.40 |
| Max. Negotiated Rate |
$6,520.00 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Aetna Managed Medicare |
$456.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,059.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$815.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$782.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$912.15
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.50
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$1,059.50
|
| Rate for Payer: Quartz Medicare Advantage |
$978.00
|
| Rate for Payer: The Alliance Commercial |
$6,520.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RXBILIARY 10FR 5CM #4560
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.70 |
| Max. Negotiated Rate |
$1,499.60 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$978.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RXBILIARY 10FR 5CM #4560
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.40 |
| Max. Negotiated Rate |
$6,520.00 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Aetna Managed Medicare |
$456.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,059.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$815.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$782.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$912.15
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.50
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$1,059.50
|
| Rate for Payer: Quartz Medicare Advantage |
$978.00
|
| Rate for Payer: The Alliance Commercial |
$6,520.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RXBILIARY 10fr x 12cm
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.40 |
| Max. Negotiated Rate |
$6,520.00 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Aetna Managed Medicare |
$456.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,059.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$815.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$782.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$912.15
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.50
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$1,059.50
|
| Rate for Payer: Quartz Medicare Advantage |
$978.00
|
| Rate for Payer: The Alliance Commercial |
$6,520.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RXBILIARY 10fr x 12cm
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.70 |
| Max. Negotiated Rate |
$1,499.60 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$978.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RXBILIARY 10fr x 7cm
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2983113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.70 |
| Max. Negotiated Rate |
$1,499.60 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$978.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RXBILIARY 10fr x 7cm
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2983113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.40 |
| Max. Negotiated Rate |
$6,520.00 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Aetna Managed Medicare |
$456.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,059.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$815.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$782.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$912.15
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.50
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$1,059.50
|
| Rate for Payer: Quartz Medicare Advantage |
$978.00
|
| Rate for Payer: The Alliance Commercial |
$6,520.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RX BILIARY 10fr x 7cm 4561
|
Facility
|
OP
|
$8,784.00
|
|
| Hospital Charge Code |
2969417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,459.52 |
| Max. Negotiated Rate |
$35,136.00 |
| Rate for Payer: Aetna Commercial |
$7,905.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,554.24
|
| Rate for Payer: Aetna Managed Medicare |
$2,459.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,709.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,392.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,216.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.52
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,081.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,915.53
|
| Rate for Payer: Health EOS Commercial |
$7,817.76
|
| Rate for Payer: HFN Commercial |
$8,081.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,588.00
|
| Rate for Payer: Multiplan Commercial |
$7,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,270.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.16
|
| Rate for Payer: Quartz Commercial |
$5,709.60
|
| Rate for Payer: Quartz Medicare Advantage |
$5,270.40
|
| Rate for Payer: The Alliance Commercial |
$35,136.00
|
| Rate for Payer: WEA Trust Commercial |
$4,831.20
|
| Rate for Payer: WPS Commercial |
$6,506.31
|
|
|
STENT RX BILIARY 10fr x 7cm 4561
|
Facility
|
IP
|
$8,784.00
|
|
| Hospital Charge Code |
2969417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,304.16 |
| Max. Negotiated Rate |
$8,081.28 |
| Rate for Payer: Aetna Commercial |
$7,905.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,554.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.52
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,081.28
|
| Rate for Payer: Health EOS Commercial |
$7,817.76
|
| Rate for Payer: HFN Commercial |
$8,081.28
|
| Rate for Payer: Multiplan Commercial |
$7,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,270.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.16
|
| Rate for Payer: Quartz Commercial |
$5,270.40
|
| Rate for Payer: WEA Trust Commercial |
$4,831.20
|
| Rate for Payer: WPS Commercial |
$6,506.31
|
|
|
STENT RX BILIARY 7FR. 10CM
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2983112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.40 |
| Max. Negotiated Rate |
$6,520.00 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Aetna Managed Medicare |
$456.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,059.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$815.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$782.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$912.15
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.50
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$1,059.50
|
| Rate for Payer: Quartz Medicare Advantage |
$978.00
|
| Rate for Payer: The Alliance Commercial |
$6,520.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RX BILIARY 7FR. 10CM
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2983112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.70 |
| Max. Negotiated Rate |
$1,499.60 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$978.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RX BILIARY 7FR. 12CM 4558
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.40 |
| Max. Negotiated Rate |
$6,520.00 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Aetna Managed Medicare |
$456.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,059.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$815.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$782.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$912.15
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.50
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$1,059.50
|
| Rate for Payer: Quartz Medicare Advantage |
$978.00
|
| Rate for Payer: The Alliance Commercial |
$6,520.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RX BILIARY 7FR. 12CM 4558
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.70 |
| Max. Negotiated Rate |
$1,499.60 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$978.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RX BILIARY 7FR. 7CM
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.40 |
| Max. Negotiated Rate |
$6,520.00 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Aetna Managed Medicare |
$456.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,059.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$815.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$782.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$912.15
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.50
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$1,059.50
|
| Rate for Payer: Quartz Medicare Advantage |
$978.00
|
| Rate for Payer: The Alliance Commercial |
$6,520.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RX BILIARY 7FR. 7CM
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.70 |
| Max. Negotiated Rate |
$1,499.60 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$978.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RX BILIARY 8.5FR. 10CM
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.40 |
| Max. Negotiated Rate |
$6,520.00 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Aetna Managed Medicare |
$456.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,059.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$815.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$782.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$912.15
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.50
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$1,059.50
|
| Rate for Payer: Quartz Medicare Advantage |
$978.00
|
| Rate for Payer: The Alliance Commercial |
$6,520.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RX BILIARY 8.5FR. 10CM
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.70 |
| Max. Negotiated Rate |
$1,499.60 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$978.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RX BILIARY 8.5FR. 12CM
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.70 |
| Max. Negotiated Rate |
$1,499.60 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$978.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RX BILIARY 8.5FR. 12CM
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.40 |
| Max. Negotiated Rate |
$6,520.00 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Aetna Managed Medicare |
$456.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,059.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$815.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$782.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$912.15
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.50
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$1,059.50
|
| Rate for Payer: Quartz Medicare Advantage |
$978.00
|
| Rate for Payer: The Alliance Commercial |
$6,520.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RX BILIARY 8.5FR. 5CM
|
Facility
|
OP
|
$1,812.00
|
|
| Hospital Charge Code |
2972469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.36 |
| Max. Negotiated Rate |
$7,248.00 |
| Rate for Payer: Aetna Commercial |
$1,630.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,558.32
|
| Rate for Payer: Aetna Managed Medicare |
$507.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,177.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$906.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$869.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$960.36
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$1,667.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,014.00
|
| Rate for Payer: Health EOS Commercial |
$1,612.68
|
| Rate for Payer: HFN Commercial |
$1,667.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,359.00
|
| Rate for Payer: Multiplan Commercial |
$1,449.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,087.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,667.04
|
| Rate for Payer: Quartz Beloit One Network |
$887.88
|
| Rate for Payer: Quartz Commercial |
$1,177.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,087.20
|
| Rate for Payer: The Alliance Commercial |
$7,248.00
|
| Rate for Payer: WEA Trust Commercial |
$996.60
|
| Rate for Payer: WPS Commercial |
$1,342.15
|
|
|
STENT RX BILIARY 8.5FR. 5CM
|
Facility
|
IP
|
$1,812.00
|
|
| Hospital Charge Code |
2972469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.88 |
| Max. Negotiated Rate |
$1,667.04 |
| Rate for Payer: Aetna Commercial |
$1,630.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,558.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$960.36
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$1,667.04
|
| Rate for Payer: Health EOS Commercial |
$1,612.68
|
| Rate for Payer: HFN Commercial |
$1,667.04
|
| Rate for Payer: Multiplan Commercial |
$1,449.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,087.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,667.04
|
| Rate for Payer: Quartz Beloit One Network |
$887.88
|
| Rate for Payer: Quartz Commercial |
$1,087.20
|
| Rate for Payer: WEA Trust Commercial |
$996.60
|
| Rate for Payer: WPS Commercial |
$1,342.15
|
|
